Imaging: Ultrasound I

Question 1

When an ultrasound machine is in cardiac mode, where is the probe marker on the screen?

Answer 1

To the left (matches where your heart is in your body)

Question 2

1. What is the best view to estimate ejection fraction?
2. What valves is this fraction based on, and what is the normal range of ejection fraction for a healthy adult?
3. How do you know a mitral valve is working properly to ensure correct ejection fraction?

Answer 2

1. Parasternal long axis
2. Mitral Valve
   
   • 60 to 65%
3. The valve slaps up to hit the septum without getting “stuck” anywhere.
   
   • You estimate the ejection fraction by seeing the “relative loss of function” of the mitral valve.

Question 3

What are the 5 steps of the Seldinger technique for central lines?

Answer 3

Question 4

1. What is the best view for seeing a pericardial effusion?

Answer 4

1. SUBXIPHOID but you can use any view

Question 5

What percentage of patients die if you don’t see cardiac activity?

Answer 5

99.999999999999%

Question 6

What kind of probe do you use for cardiac POCUS and why?

Answer 6

• Phased Array
  
  • Has a smaller footprint
  • Sees motion well
  • Low frequency, so has good depth

Question 7

The right panel shows a normal heart. What is the red arrow pointing at in the left panel.

Answer 7

Effusion

Question 8

• Where are the following structures in this figure?
  • Right Ventricle
  • Left Ventricle
  • Mitral Valve

Answer 8

Mitral valve is the white ring within the left ventricle

Question 9

You are doing a Parasternal long axis view

• Where is the probe in relation to the intercostal spaces?
• Where is the probe marker pointing?
• What is this view BEST used for?

Answer 9

Question 10

Where are the following structures in the image provided?

• Left Atrium
• Left Ventricle
• Aortic Outflow
• Right Ventricle
• Descending Aorta

Answer 10

Question 11

In ultrasound-guided central lines, what are the two planes of view you can use?

Answer 11

1. In-plane (long axis)
   
   • little more complicated
2. Out of plane (short axis)

Question 12

In this parasternal short axis view, point out the pericardial effusion as well as the left ventricle.

Answer 12

Question 13

What is the difference in viewing the needle in In-plane (long axis) vs. out of plane (short axis) views?

Answer 13

In-plane (long axis)

• You can see MORE needle due to angle

Out of plane (short axis)

• You just see the part of the needle where the probe happens to be

Question 14

How does ultrasound reduce complications of central lines?

Answer 14

Decreases complications

• Pneumothorax
• Arterial puncture
• 18% down to 6%

Question 15

In a parasternal long axis view, what structure is the most important structure for determining if a patient has a pericardial effusion or a pleural effusion?

Answer 15

yellow is pericardial effusion

Question 16

How do you get into the parasternal short axis view?

Answer 16

After doing the long axis view, rotate the probe 90 degrees clockwise so that the probe marker is pointing to the LEFT shoulder.

Question 17

This is an image of a central line being performed. What is the mouse pointer hovering over?

Answer 17

Carotid Artery

Question 18

Label A and B as either parasternal long axis or parasternal short axis

Answer 18

A. Parasternal long axis

B. Parasternal short axis

Question 19

In ultrasound-guided central lines, what is held in your dominant hand?

Answer 19

Dominant hand: Needle

Other hand: Probe

Question 20

What are the 3 main things to look for in cardiac POCUS?

Answer 20

1. Pericardial Effusion
2. Ejection Fraction esitmation
3. Cardiac Activity

Question 22

What view is this?

Answer 22

Parasternal Short Axis

Question 23

What view is this?

Answer 23

PARASTERNAL LONG AXIS VIEW

Question 24

Where are the following structures in the image provided?

• Left Atrium
• Left Ventricle
• Aortic Outflow
• Right Ventricle
• Descending Aorta

Answer 24

Question 25

1. What are the three common sites for a central line?
2. What are the most common complications from a central line, aside from infection?

Answer 25

1. Sites
   
   • Internal jugular vein
   • Subclavian Vein
     
     • Not as common anymore
   • Femoral Vein
2. Arterial puncture and pneumothorax

Question 26

Label each pic as In-plane (long axis) or out of plane (short axis)

Answer 26

• Top: In-plane (long axis)
• Bottom: out of plane (short axis)